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General NPI Number Information
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NPI Number | 1407959554
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Entity Type | Organization
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Legal Business Name | CRISMALI PODIATRIC MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 18151 BEAR VALLEY RD
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City | HESPERIA
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State | CA
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Zip | 92345-4907
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Country | US
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Telephone | 760-948-7400
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Fax | 760-948-7866
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Provider Business Mailing Address
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Address Line | 18151 BEAR VALLEY RD
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City | HESPERIA
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State | CA
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Zip | 92345-4907
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Country | US
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Telephone | 760-948-7400
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Fax | 760-948-7866
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Authorized Official
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Title or Position | CEO
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Name | PETER AWAD
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Credential | DPM
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Telephone | 760-948-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E3433
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E3433
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License Number State | CA
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